Youth with inflammatory bowel disease (IBD) have high rates of depression and difficulty with daily functioning compared to age-matched peers without physical illness. Additionally, the medications used to treat IBD, specifically steroids, may induce depression, cause sleep problems, and adversely impact health-related quality of life (HRQOL). We will investigate the effects that cognitive behavioral therapy (CBT) with a physical narrative focus has on the child's emotional state and several health-related factors (e.g., HRQOL, medication adherence, IBD severity) in children and adolescents 9 -17 years of age with IBD and clinically significant depression. Participants will be randomized to either CBT designed for youth with IBD or supportive non-directive therapy (SNDT). Individuals in the CBT group will learn new cognitive strategies (i.e., reconstruction of personal physical illness narratives, coping strategies, and social skills) and alternate behaviors (i.e., positive activities, family communication, sleep hygiene, relaxation) to improve emotional (mood) and health (HRQOL, adherence, IBD severity) functioning. Participants in the time and attention control group of SNDT will receive social support and information about depression. Both groups will have parent (family) sessions provided at the beginning, middle and end of the study. For CBT these sessions will seek to improve family understanding and communication about the physical illness and the skills being taught to the patient; for (SNDT) we will provide non-directive support. The goals of this study are to assess the efficacy of the CBT versus SNDT on emotional (reducing symptoms of depression) and physical health (HRQOL, medication adherence; IBD severity) outcomes. Secondary analyses will assess changes in IBD course, pain, sleep, and illness perceptions with treatment. The relationship between health outcomes and depression will also be examined in exploratory manner. Putative moderators (e.g., anxiety, steroid use, and pubertal status) of CBT effects on depression and HRQOL will be explored. This will be the first study to explore the effects of CBT on physical health outcomes over and above the effects attributable to changes in depression in a pediatric IBD population. This approach represents an important paradigm shift in using a behavioral intervention, integrated into medical treatment, to target both emotional and physical health problems. Two sites will be used to obtain the targeted sample size of 112 per intervention group. A benefit of this research is a better understanding of both the emotional and physical health effects of chronic illness in youth and will serve to help other similar pediatric populations. The University of Pittsburgh Medical Center (UPMC)/Children's Hospital Pittsburgh and Harvard University/Children's Hospital Boston plan to collaborate on this 5 year project. This project will investigate the effects of CBT on depression and physical health-related outcomes in children and adolescents with IBD. This will be the first study that will also explore the effects of CBT on physical health outcomes over and above the effects attributable to changes in depression. A benefit of this research is that public awareness will be increased regarding both the emotional and physical health effects of chronic illness in youth and will server to help other similar pediatric populations.